System, apparatus and method for patient positioning prior to, during and/or after medical procedures

ABSTRACT

A system for positioning a patient before, during or after a medical procedure can include an arm assembly having a proximal end, an opposing distal end, and at least one joint therebetween. The joint can be configured to permit the distal end of the arm assembly to move with respect to the proximal end of the arm assembly. The proximal end of the arm assembly can be configured to be fixed with respect to a surgical table. The system can also include a ball joint mechanism attached to the distal end of the arm assembly and to a head support configured to support a patient&#39;s head. The ball joint mechanism can include a ball joint and a motor. Activation of the motor can permit or prevent movement of the ball joint.

BACKGROUND

Properly positioning or repositioning a patient prior to and duringmedical procedures can be important. For example, in cervical surgery,precise, convenient and repeatable positioning of the patient's head andneck is helpful to enable access to the surgical site. It is desirableif the surgeon or other healthcare professional is able to fix theprecise position of the patient, and also, when appropriate, change theposition to a different fixed position. Prior art surgical tables orequipment often place patients in positions that are not physiologicallyor ergonomically optimal. Position-related complications can be severeif the head and neck position are not proper.

During a medical procedure, the surgeon would generally prefer to avoidmoving through positions that strain the patient, such as placing unduetension or compression on the spine, or that could otherwise causecomplications. It can be beneficial to quickly and convenientlyreposition the patient to limit the time under anesthesia and othercomplications associated with a prolonged procedure. Such quick andconvenient reposition of the patient can also be beneficial to themedical team, thereby reducing fatigue and avoiding unnecessarydistractions. It is desirable if all repositioning can be done withoutcompromising the sterile nature of the procedure. If the surgeon orother personnel are forced to access areas behind the surgical drape(e.g., to reposition the patient), resterilization is required. Thisprolongs the procedure and introduces risks of compromising the sterilenature of the procedure.

The prior art includes various mechanical mechanisms for supporting apatient's head and neck during a cervical procedure. Certainpre-existing positioning devices have multiple adjustments or knobs thatrequire several members of the surgical team to position or repositionthe patient. In use, one individual is required to hold or otherwisesupport the patient's head, while at least a second individual isrequired to manually loosen and tighten the knobs. This can be atime-consuming and tedious way to achieve satisfactory positioning.

During position or repositioning of the patient, the relatively longtime period required for the surgeon or medical staff to support theweight of the patient is not ideal. When initially attaching existingprior art system or arms to the patient's head in a skull clamp, certainsystems require four separate knobs that must be turned and fullyseated. This can take anywhere from fifteen to forty-five seconds, andthe surgeon or medical team member is often leaning or moving innon-ergonomic or uncomfortable positions during this process. Adjustingthe patient's head orientation with prior art system or arms usuallyentails releasing two or three of the axes, repositioning, thenretightening. This process can take approximately thirty seconds, allthis time while the physician must hold the patient's head fixed. Giventhe relatively long time period to complete the above-described steps,these portion of the surgery or pre-surgery can be challenging for themedical team.

One specific example of a prior art device is the MAYFIELD® Ultra 360™Patient Positioning System (the “Mayfield”). The Mayfield hasindependent, rotating and self-locking handles, and two double-camaction locking handles for easier opening and closing for secure, quickfixation. Another specific example of a prior art system for supportingand positioning a part of a patient's body is the Allen Medical Systems,Inc. C-Flex® design described in U.S. Pat. No. 8,413,660 (“the '660patent”), the disclosure of which is hereby incorporated by reference inits entirety. The device of the '660 patent includes at least twojoints, each of which has a locked state and an unlocked state, and arelease system for allowing an operator, such as a surgeon, to selectbetween the locked state and the unlocked state. The release system ofthe '660 patent has an operator control interface remote from the jointsand at a location that enables the operator to support the weight of thebody part while at least one of the joints is in the unlocked state.

The above-described conventional devices have several limitations. Forexample, fully mechanical devices require or result in relatively abruptmovements of the patient prior to or during surgery. The prior artdevices often require the surgeon or other medical personnel to “breakscrubs” by entering or accessing an area behind or beneath the surgicaldrape. Some of these devices allow adjustability in only discreteincrements, rather than offering a continuous spectrum of adjustability.The discrete adjustability can result in suboptimal positioning.

In the case of the '660 patent, the ball pivot 166 is located proximateto the device's joint linkages, near the mounting to the surgical table,which is a relatively far distance from the patient's head, therebycausing delicate or relatively minor movements of the patient's head tobe more challenging. Other movements of the system of the '660 patentrequire unlocking of thumbscrews that are remote from the correspondingjoint. Therefore, patent positioning and repositioning of the '660patent often requires multiple people and potential compromise of thesterile nature of the procedure. In addition, in an unlocked state,movement of the arm of the '660 patent is not particularly smooth. Thesystem of the '660 patent has a relatively high stiction to start eachmotion, which causes movement of the patient to be jerky.

SUMMARY

In one embodiment, the presently disclosed technology is directed to asystem for positioning a patient before, during or after a medicalprocedure. The system can include an arm assembly having a proximal end,an opposing distal end, and at least one joint therebetween. The jointcan be configured to permit the distal end of the arm assembly to movewith respect to the proximal end of the arm assembly. The proximal endof the arm assembly can be configured to be fixed with respect to asurgical table. The system can also include a ball joint mechanismattached to (i) the distal end of the arm assembly and (ii) a headsupport configured to support a patient's head. The ball joint mechanismcan include a ball joint and a motor. Activation of the motor can permitor prevent rotation of the ball joint

In another embodiment, the presently disclosed technology is directed toa system for positioning a patient before, during or after a medicalprocedure. The system can include a surgical table, a base removablyattachable to the surgical table, and a head support configured tocontact the patient's head. At least a portion of the head support caninclude at least one exposed electrical contact. The system can alsoinclude an arm assembly having a proximal end, an opposing distal end,at least three spaced-apart joints therebetween, and at least two armlinks that attach the joints. Each joint can be configured to permit thedistal end of the arm assembly to move with respect to the proximal endof the arm assembly. The proximal end of the arm assembly can beconfigured to be fixed with respect to the base attached to the surgicaltable. At least one of the two arm links can include at least onebattery. The system can also include a ball joint mechanism attached to(i) the distal end of the arm assembly and (ii) the head support. Theball joint mechanism can include a ball joint and a motor. Activation ofthe motor can permit or prevent movement of the ball joint.

In yet another embodiment, the presently disclosed technology isdirected to a system for positioning a patient before, during or after amedical procedure. The system can include a base having a first body anda second body. The first body can be attachable to a surgical table andmovable with respect to the surgical table along a first axis. Thesecond body can be movable with respect to the first body in a directionperpendicular to the first axis. The system can also include an armassembly having a proximal end, an opposing distal end, and at least onejoint therebetween. The joint can be configured to permit the distal endof the arm assembly to move with respect to the proximal end of the armassembly. At least a portion of the proximal end of the arm assembly canbe inserted into the first body of the base and fixed thereto.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofthe invention, will be better understood when read in conjunction withthe appended drawings. For the purpose of illustrating the invention,there are shown in the drawings various illustrative embodiments. Itshould be understood, however, that the invention is not limited to theprecise arrangements and instrumentalities shown. In the drawings:

FIG. 1 is a perspective view of at least a portion of a system orapparatus according to an embodiment of the present disclosure;

FIG. 2 is another perspective view of the structure shown in FIG. 1;

FIG. 3 is a perspective view of an embodiment of a component of thestructure shown in FIGS. 1 and 2, wherein a segment of the component isshown in cross-section taken along line 3-3 of FIG. 2;

FIG. 4 is a perspective view of at least a portion of the componentshown in FIG. 3; wherein a segment of the component is shown aspartially transparent for clarity;

FIG. 5 is a perspective view of an embodiment of another component ofthe structure shown in FIG. 1, wherein segments of the component areshown as partially transparent for clarity;

FIG. 6 is a cross-sectional perspective view of the component shown inFIG. 5, taken along line 6-6 of FIG. 5;

FIG. 7 is another perspective view of the structure shown in FIG. 1,wherein the structure is shown attached to an embodiment of yet anothercomponent of the presently disclosed technology;

FIG. 8 is a magnified perspective view of a segment of the structureshown in FIG. 7;

FIG. 9 is a perspective view of an embodiment of still another componentof the system or apparatus according to an embodiment of the presentdisclosure;

FIG. 10 is another perspective view of the component shown in FIG. 9;

FIG. 11 is a perspective view of an embodiment of a component of thesystem or apparatus according to an embodiment of the presentdisclosure;

FIG. 12 is a perspective view of an embodiment of a further component ofthe system or apparatus according to an embodiment of the presentdisclosure;

FIG. 13A is another perspective view of the component shown in FIG. 12;

FIG. 13B is a cross-sectional side elevational view of a portion of thecomponent shown in FIG. 13A, wherein two clasps are shown in a fullyopen or upward position and wherein the cross-section is taken throughthe first or larger clasp;

FIG. 13C is another cross-sectional side elevational view of a portionof the component shown in FIG. 13A taken along the same plane as in FIG.13B, wherein one clasp is shown in a closed position and another claspis shown in a fully open or upward position;

FIG. 13D is a cross-sectional side elevational view of a portion of thecomponent shown in FIG. 13A taken along a different plane than FIGS. 13Band 13C, wherein the clasps are shown in the same orientation as shownin FIG. 13C and wherein the cross-section is taken through the second orsmaller clasp;

FIG. 13E is yet another cross-sectional side elevational view of aportion of the component shown in FIG. 13A taken along the same plane asFIGS. 13B and 13C, wherein both clasps are shown in a closed position;

FIG. 13F is a magnified cross-sectional side elevational view of aportion of the component shown in FIG. 13A taken along the same plane asFIG. 13D, wherein both clasps are shown in a closed position;

FIG. 14 is a perspective view of another embodiment of the componentshown in FIG. 11;

FIG. 15 is another perspective view of the component shown in FIG. 14;

FIG. 16 is a perspective view of one configuration of at least certaincomponents of the present disclosure;

FIG. 17 is a perspective view of a second configuration of at leastcertain components of the present disclosure; and

FIG. 18 is a side elevation view of the configuration shown in FIG. 17;

FIG. 19 is a perspective view of one embodiment of a surgical drape usedwith the system or apparatus; and

FIG. 20 is another perspective view of the surgical drape used with thesystem or apparatus.

DETAILED DESCRIPTION

While systems, apparatus and methods are described herein by way ofexamples and embodiments, those skilled in the art recognize that thesystems, apparatus and methods of the presently disclosed technology arenot limited to the embodiments or drawings described. It should beunderstood that the drawings and description are not intended to belimited to the particular form disclosed. Rather, the intention coversall modifications, equivalents and alternatives falling within thespirit and scope of the appended claims. Any headings used herein arefor organizational purposes only and are not meant to limit the scope ofthe description or the claims. As used herein, the word “may” is used ina permissive sense (i.e., meaning having the potential to) rather thanthe mandatory sense (i.e., meaning must). Similarly, the words“include,” “including,” and “includes” mean including, but not limitedto. Unless specifically set forth herein, the terms “a,” “an” and “the”are not limited to one element but instead should be read as meaning “atleast one.” The term “actuator” is broadly defined herein to mean anycomponent capable of at least initiating movement or control of amechanism or system, and includes a trigger, a button, a switch or anyother enabling device. The terminology includes the words noted above,derivatives thereof and words of similar import.

Referring to the drawings in detail, wherein like numerals indicate likeelements throughout, one embodiment of the presently disclosedtechnology is directed to a modular, multi-component system, apparatusand method that allows a surgeon and/or a medical team to position andreposition a patient before, during and/or after surgery thoughelectrical and/or mechanical means. As compared to the prior art, thecervical management system of one embodiment of the presently disclosedtechnology increases both the speed at which a patient can be positionedand repositioned in a desirable configuration and the reliability thatthe desired configuration will be achieved. The term “patient” isbroadly defined herein to include human patients of all sizes, gendersand demographics, as well as animals (e.g., for veterinarian purposes).

The presently disclosed technology allows a single surgeon or a singlehealthcare professional, as opposed to a team of two or more, to makeinter-operative (e.g., both preoperative and postoperative) adjustmentsto the patient without having to “break scrubs.” As a result, moreefficient and effective surgeries should result. The system orapparatus, generally designed 100, of the presently disclosed technologyincludes components with specific motion ranges and adjustmentcapabilities that can be combined in different ways to address differentclinical needs for (i) simple or complex procedures (for example, butnot limited to, cervical procedures and neurosurgery), (ii)intra-operative adjustment, (iii) small or large adjustment ranges,and/or (iv) prone positioning for cervical and/or thoracic/lumbar. Thesystem or apparatus, therefore, can enable precise, smooth andcontinuous movement without “jerking” or any sudden movements. Thesystem or apparatus 100 can support movement of the patient in alldegrees of freedom (i.e., lateral, longitudinal, vertical, yaw, pitchand role). The system or apparatus can provide optimized sagittal motionrange, floating lateral and longitudinal motion to allow for low forcecompensation during head adjustment,

FIGS. 1-7 and 16-18 show embodiments of an arm assembly, generallydesignated 200, a ball joint mechanism, generally designated 400, and afirst operator control interface, generally designated 300, of thepresently disclosed technology. In one embodiment, the arm assembly 200,the ball joint mechanism 400, and the first operator control interface300 can be permanently or non-removably attached. In another embodiment,one or more of these components can be removably attached to one anotherto create a modular system of interchangeable parts. As described indetail below, at least a portion of the arm assembly 200 can pivot, spinand/or rotate with respect to at least a portion of the ball jointmechanism 400, and at least a portion of the ball joint mechanism 400can pivot, spin and/or rotate with respect to at least a portion of thefirst operator control interface 300. Such relative movement of thesecomponents gives the surgeon and other healthcare professional(s)increased control of the patient's positioning prior to, during and/orafter surgery, and contributes to the overall effectiveness andfunctionality of the system, apparatus and method of the presentlydisclosed technology.

As shown in FIGS. 1-4, 7 and 16-18, the arm assembly 200 can include aproximal end 202 and an opposing distal end 204. One or morespaced-apart rotary joints 220 a, 220 b, 220 c can be located betweenthe ends 202, 204. One or more of the joints 220 a, 220 b, 220 c can bepivot joints. In one embodiment, when making an analogy to a human arm,the first or proximal-most joint 220 c can function as a shoulder joint;the second or mid-joint 220 b can function as an elbow joint; the thirdor distal-most joint 220 a can function as a wrist joint. One or morelink arms 218 a, 218 b can be connected by one or more of the joints 220b. The presently disclosed technology can employ an arm assembly 200with more than three rotary joints (or joints of any type) and more thantwo arm links as shown herein, if such additional motion or dexteritywould be beneficial to the surgeon or other healthcare professional.

Each joint 220 a, 220 b, 220 c can be configured to permit the distalend 204 of the arm assembly 200 to move with respect to the proximal end202 of the arm assembly 200. At least a portion of the proximal end 202of the arm assembly 200 can be coupled (directly or indirectly) and/orremovably or permanently fixed (directly or indirectly) with respect toa support apparatus 150, such as a surgical table. At least a portion ofthe distal end 204 of the arm assembly 200 can be configured to becoupled (directly or indirectly) and/or removably or permanently fixed(directly or indirectly) to one or more devices, such as a deviceconfigured to support a patient's head. In one embodiment, one or morebatteries 222 or other power source(s) can be enclosed within one ormore of the link arms 218 a, 218 b, and operatively connection (e.g.,through wires) to one or more components of the system 100 that requireelectrical power. The batteries 222 can be a convenience by allowing thesystem to be wireless. The batteries 222 can be rechargeable.

As mentioned, one problem with conventional head positioning devices isthat the weight of the patient's head and neck, combined with the weightof the positioning apparatus, can make it difficult for the surgeon tosafely support the patient's anatomy at the instant the joints release.To address this limitation, the release of the rotary joints 220 a, 220b, 220 c and the ball joint mechanism 400 can be safety-enabled toprevent accidental unlocking. In addition, one or more of the joints 220a, 220 b, 220 c can include a motion damping mechanism, which, when oneor more of the joints 220 a, 220 b, 220 c are in an unlocked state,provides an appropriate inertia opposing any acceleration of the joints220 a, 220 b, 220 c and thereby minimize unwanted motion of thepatient's head and/or neck.

In particular, referring to FIGS. 3 and 4, one or more of the joints 220a, 220 b, 220 c can include at least one brake 270 operatively connectedto at least one gear or gear train 272. Each brake 270 can be anelectro-mechanical or an electro-magnetic fail safe brake, and each gear272 can be a high ratio harmonic gear drive, strain wave, planetary, orother type gear box. The gear(s) 272 are not limited to the above typeor configuration, as one or more could be other types of gears, such asplanetary or cycloidal or even direct drive (no gearing whatsoever).Each gear box 272 can reflect or produce the brake rotor inertia to theuser (e.g. surgeon), multiplied by the square of the gear ratio toprovide inertial dampening. This damping can prevent sudden dropping ofthe patient's head, for example, when the joint release mechanism isengaged or when one or more of the operator control interfaces arereleased by the surgeon or other healthcare professional. One or more ofthe joints 220 a, 220 b, 220 c can include additional features orcomponents to add in the functionality of the system. For example, anencoder can be positioned at or in one or more of the joints 220 a, 220b, 220 c to aid the medical team's ability to return the arm assembly200 and/or the entire system to a desired or original position. One ormore counterbalance springs and/or motors can be employed on or in oneor more of the joints 220 a, 220 b, 220 c to provide a gravity assistand/or active positioning.

In one embodiment, the higher the ratio of the gear box(es) 272, thesmaller the brake(s) 270 can be to accomplish the desired functionality.Furthermore, the timing of the release of one or more of the joints 220a, 220 b, 220 c and/or the ball joint mechanism 400 could be staggeredsuch that the weight of the patients head and neck is progressivelytransferred from the device to the operator, allowing the surgeon timeto react to any sudden drop of the patient's head. One or more torsionalor other spring type can be operatively connected to the joint orgear(s) 272 that could provide a gravity compensation torque, furtherreducing the possibility of sudden acceleration of the patient's headand neck

The rotary joints 220 a, 220 b, 220 c and ball joint mechanism 400 canbe configured to lock in any precise, desired head posture and to notdrift while locking. The brake(s) 270 and/or a motor (described indetail below) of the ball joint mechanism 400 can lock quickly (e.g.,measured in milliseconds) so that there is no need for the surgeon orother healthcare professional to hold the patient's head still for anextended period of time (which is required by prior art devices).

One or more of the batteries 222 can supply power to each brake 270and/or motor (described in detail below) of the ball joint mechanism400. The present disclosure is not limited to batteries as the solepower source for these or other electrical components of the system, asother well-known power sources can be used. For example, the system orany portion thereof could plug directly into the surgical table(supplied with power) or a wall outlet to get its power. As described indetail below, one or more operator control interfaces are operativelyand/or electrically coupled to each brake 270, each motor, and/or eachbattery 222 or other power source. In one embodiment, upon activation ofone or more of the operator control interfaces, electrical power can besupplied to one or more of the brakes 270 and/or motor(s).

In one embodiment, one or more of the brakes 270 and motor(s) areconfigured to be “fail safe.” Thus, when power is removed from thebrakes 270 and/or motor(s), one or more of the link arms 218 a, 218 band/or the ball joint mechanism 400 can fully lock-up, which is thenormal state during surgery. When power is applied (via the enableand/or release buttons described herein), the brakes 270 and/or motor(s)are free to rotate. Additional motors and servos could be added toprovide any amount of holding or drive torque. In an alternativeembodiment, one or more brakes, motors or other components can applyvariable friction to one or more of the link arms 218 a, 218 b and/orthe ball joint mechanism 400, thereby slowing movement of thesecomponents.

The above-described arrangement and features allow one or more of thejoints 220 a, 220 b, 220 c and/or each ball joint mechanism 400 to havean unlocked state and a locked state. In the unlocked stated, each joint220 a, 220 b, 220 c and each ball joint mechanism 400 can be freelymoveable without any or only negligible resistance. This can allow formaximum manipulation or maneuverability of the entire system. In thelocked state, each joint 220 a, 220 b, 220 c and each ball jointmechanism 400 can be fixed, thereby providing maximum support and/orstability to the patient. Of course, not all of the joints 220 a, 220 b,220 c or the ball joint mechanism 400 are required to be locked orunlocked at the same time. For example, one or more of the joints 220 a,220 b, 220 c and/or ball joint mechanism 400 can be unlocked, while oneor more of the remaining joints 220 a, 220 b, 220 c or ball jointmechanism 400 can be locked. Such a configuration allows for some ormore finite movement or manipulation of the system.

As shown in FIGS. 1 and 2, a first mount or quick connection 230 can belocated at or proximate to the proximal end 202 of the arm assembly 200.The first mount 230 can include a body 260 having a longitudinal axis L(see FIG. 2) that can extend in a plane defined by the link arms 218 a,218 b. At least a portion of the first mount 230 can be sized, shapedand/or configured to fit into and/or be received by a recess orreceptacle of a base (embodiments described in detail below), forexample, that attaches to a surgical table. In one embodiment, the firstmount 230 can be fixedly or permanently attached to the proximal-mostrotary joint 220 c. The proximal-most link arm 218 b can rotate aboutthe first mount 230 as a result of the proximal-most rotary joint 220 c.A distal end 232 of the first mount 230 can include a tapered portion tofacilitate easy insertion into the recess or receptacle. An opposingproximal end 234 can include a spring-biased tab or button 236.Depression of the button 236 can retract a projection 238 biasedoutwardly from the first mount 230, which can facilitate removal of thefirst mount 230 from the recess or receptacle. Opposing sides of thefirst mount 230 can include grooves or cut-outs 239 a, 239 b designed tomate with or complement portions of the recess or receptacle.

FIGS. 5 and 6 show detailed views of one embodiment of the ball jointmechanism 400 of the presently disclosed technology. The ball jointmechanism 400 can include at least one ball joint 410 operativelyconnected to at least one motor 420, such as a DC brush motor. The motor420 can be operatively connected to one or more of the batteries 220 andcan be activated by one or more of the operator control interface(s).The ball joint 410 can be a conventional three-degree-of-freedom balljoint allowing rotation in all three axes. The ball joint 410 caninclude a ball seat 412 and a swivel ball 414. A rod or pin 416, whichcan be threaded, can extend through at least a portion of each of theball seat 412 and the swivel ball 414 and into a biasing compressionspring pack 460. The biasing compression spring pack 460 can be a stackof spring washers or a spring pack.

An opening in a bottom of the ball seat 412, which the rod 416 passesthrough, can be a slot, restricting motion in one plane and thuscreating a two-degree-of-freedom ball joint. If the ball joint'srestricted plane is coincident with the plane the three rotary jointsenable motion in, redundancy of motion will be reduced. In oneembodiment, because of this slot that can restrict motion of the balljoint 410, the ball joint 410 is only able to make yaw and rolladjustments. In this embodiment, when the surgeon wants to make asagittal plane (i.e., pitch) adjustment, he/she rotates all three joints220 a, 220 b, 220 c.

Through a thrust bearing/bushing interface 440, the lower end of the rod416 can contact or engage, but translate independently of, the upper endof a threaded shaft 462, such as a ball screw or lead screw. The lowerflange or shoulder of interface 440 can act as a bushing becausethreaded shaft 462 can rotate, but the rod 416 does not. The lowerflange can act as a thrust bearing limiting motion when the spring pack460 pushes the rod 416 downwardly. In one embodiment, a bottom end ofthe threaded shaft 462 can extend into and engage a first gear 430 a.The first gear 430 a can matingly engage a second gear 430 b, which inturn matingly engages a clutch 430 c. The clutch 430 c can be a one-waybearing or a Sprag type clutch. The clutch 430 c is not limited to theexact location shown in FIGS. 5 and 6. For example, the clutch 430 ccould be moved from proximate the second gear 430 b to proximate theopposite first gear 430 a. A gear reducer 480 can be attached at one endto the clutch 430 c and at an opposing (e.g., upper) end to the motor420.

The threaded shaft 462 can be or form a portion of a rotatory-to-linear(or vice versa) device. In particular, a cylindrical ball screw nut orlead screw nut 444 (see FIG. 6) can be keyed in the housing 445,enabling the nut 444 to move linearly as the threaded shaft 462 isrotated. The ball screw nut 444 can be positioned directly above abearing. Rotation of the threaded shaft 462 in one direction (e.g.,clockwise) can drive or move the ball screw nut 444 at least slightlyupwardly, thereby at least slightly compressing the spring pack 460 andthus driving the rod 416 at least slightly upwardly. Likewise, downwardmotion of the rod 416 (e.g., driven by the force of the spring pack 460)can cause the ball screw nut 444 to translate or otherwise move at leastslightly downward. This motion causes the threaded shaft 462 to “backdrive.”

Linear motion of the ball screw nut 444 can thus push upwardly on therod 416. In order to push the rod 416 upwardly, sufficient motor poweris needed to compress the spring pack 460. When the motor power isreleased, the spring pack 460 can push the ball screw nut 444 backdownwardly, thereby causing the screw shaft 462 to rotate. The purposeof the clutch 430 c is to minimize the amount of friction and inertiathat must be overcome. With the clutch aligned properly, the motor andits gearbox do not need to rotate, which assures a quick and safelock-up of the ball joint 410 of the ball joint mechanism 400.

In one embodiment, the ball joint mechanism 400 can be biased to lockthe ball joint 410, thereby preventing movement in either of the twodegrees of freedom. More particularly, in one embodiment, with the motor420 in a relaxed or “off” state, the biasing spring pack 460 can biasthe rod 416 downwardly, thereby moving the swivel ball 414 downwardlyand into engagement with the ball seat 412. In addition, the biasingspring pack 460 can also push the ball seat 412 into engagement with acup housing 442 (see FIG. 6) beneath the ball seat 412 and above thebiasing spring pack 462. Such engagement can lock the position of balljoint 410 and prevent its rotation. This functionality can help tomaintain the system 100 in a desired configuration or position, therebysupporting the patient while the surgeon or other healthcareprofessional performs the medical procedure. In one embodiment, thepatient's head is attached (indirectly) to the ball seat 412, so theabove-described configuration and components provide two frictionalsurfaces, both generating holding torque, thereby creating a dual(concentric) ball joint. The torque is “doubled” because the ball seat412 is captured and tightly clamped on both its inner (e.g., upper) andopposing outer (e.g., lower) ball surfaces.

When it is desirable to reposition the patient, power can be supplied tothe motor 420, which, in one embodiment, can cause the second gear 430 bto rotate via engagement of the clutch 430 c. Rotation of the secondgear 430 b will engage the first gear 430 a, thereby causing rotation ofthe threaded shaft 462. Rotation (e.g., clockwise when viewed frombeneath the ball joint mechanism 400) of the threaded shaft 462 caneffectuate a change of the biasing spring pack 460 that can release theball joint 410. For example, in one embodiment, this rotation of thethreaded shaft 462 can cause the ball screw nut 444 and the lower end ofthe spring pack 460 to be moved at least slightly upwardly, thereby atleast slightly compressing the spring pack 460, which in turn canrelease or at least reduce tension or a downward force previouslyapplied to the rod 416. This can permit the rod 416 to move at leastslightly upwardly and release the ball joint 410 from a clamp created bycompression of the swivel ball 414 onto the ball seat 412 by the rod416. The clamp can be a double (concentric) surface ball joint clamp.

When the motor 420 is turned “off” or power is cut to the motor 420,torque is no longer applied to the threaded shaft 462. When this occurs,the force of the compressed spring pack 460 pushes the ball screw nut444 at least slightly downwardly. Since the ball screw nut 444 is keyed,this linear motion causes the threaded shaft 462 to rotate (i.e., backdrive). In this embodiment, without the clutch 430 c, the entiredrivetrain, including the motor 420 would back drive.

Thus, in one embodiment, when the motor 420 is engaged, activated orpowered, the rod 416 can permit the swivel ball 414 of the ball joint410 to move in two degrees of motion, but can prevent the ball joint 410from moving or rotating in a third degree of motion. However, when themotor 420 is not engaged, activated or powered, the rod 416 can preventany motion or rotation of the ball joint 410. In an alternativeembodiment, as understood by those skilled in the art, the drive drainand/or components of the ball joint mechanism 400 can be designed suchthat activation of the motor 420 prevents movement of the ball joint 410and deactivating the motor 420 permits movement of the ball joint 410.

In one embodiment, the first and second gears 430 a, 430 b can beomitted from the design. For example, the same or similar functionalitycould be accomplished with an “in-line” design, where the motor 420, theclutch 430 c, and the ball screw 462 are all on the same axis. Such adesign would eliminate the gear set, if that is desirable, but coulddouble the height of the ball joint mechanism 400 (which could beacceptable in certain circumstances).

As shown in FIGS. 1, 2 and 16-18, the position of the ball jointmechanism 400 and/or the ball joint 410 relative to other components ofthe system 100 can be advantageous. In one embodiment, the ball joint410 can be located or positioned proximate to the patient's head, andgenerally between the patient's head and the arm assembly 200. Whenattempting to make minute changes to the position of the patient's head,it can be beneficial for the ball joint 410 to be located proximate tothe patient's head, because all rotation of the patient's head affectsthe patient's neck. Specifically, when reorienting the patients head inthe coronal plane (yaw), rotating the head about a point located closeto the neck will minimize translation of the head in the coronal plane,thus limiting transverse motion of the cervical vertebra. This proximityof the two-degrees of freedom provided by the ball joint 410 allows thesurgeon or other healthcare professional to make minute or finitechanges in the orientation of the patient's head with minimal effect onthe surgical site. In the prior art, any ball joint is spaced-apart fromthe patient's head, such that all or a majority of any articulating armis positioned between the patient's head and the ball joint. Such anarrangement in the prior art can limit the effectiveness and range ofcoronal plane adjustments.

In one embodiment, one important feature of the ball joint 410 and/orthe ball joint mechanism 400 is the locking/unlocking function. Lockingcan be provided by the failsafe spring pack 460, which can be similar tospring packs employed in electro-mechanical brakes, such as those usedon the rotary joints 220 a, 220, 220 c. Once power to the motor 420 isremoved, the clutch 430 c can allow the ball joint 410 to lock and/or belocked quickly because the inertia and friction of the motor 420 doesnot need to be back driven, thus enhancing the safety of the system. Themotor 420 can provide the unlocking function by rotating the ball screw462 and compressing the brake(s) 270. Other important features of theball joint 410 are the concentric locking surfaces, essentially doublingthe holding torque, and the pin 416 in the slot, which reduces it to twodegree-of-freedom and thereby eliminating the sagittal plane adjustmentconflict.

Referring to FIGS. 1 and 2, the first operator control interface 300 caninclude a body 302 having a first actuator 304 and a second actuator306. The first and second actuators 304, 306 can be spaced-apart. Thefirst actuator 304 can be in the form of a spring-actuated trigger ortab, which can be depressed and/or engaged by a user when the usergrasps the body 302. The second actuator 306 can be in the form aspring-actuated push button, which can be depressed and/or engaged by auser's finger. In operation, when the user grasps the body 302 tightly,enabling actuator 304, he/she is exerting control of the device and islikely to have a strong enough grip to support the weight of theunlocked actuator. In this position, it can be most comfortable for theuser to depress the second actuator 306 with his or her thumb. Each ofthe first and second actuators 304, 306 of the first operator controlinterface 300 can be operatively and/or electrically connected to themotor 420 of the ball joint mechanism 400 and/or the brake(s) 270 of oneor more of the joints 220 a, 220 b, 220 c in a manner requiring BOTHactuators 304, 306 be enabled in order to free the mechanism. Thus, inone embodiment, the surgeon or other healthcare professional can move orreposition the patient only through exerting control of the mechanism byengagement of the first actuator 304, then or subsequently by triggeringthe mechanism by engagement of the second actuator 306. In oneembodiment, the actuators 304, 306 could be engaged simultaneously toproduce or permit the desired movement.

The first operator control interface 300 is not limited to inclusion oftwo separate, spaced-apart actuators. For example, the first operatorcontrol interface 300 could include three or more actuators, dependingupon the desired functionality of the system. An additional actuator 307(see FIG. 1) can be located on an opposite end of the body 302 from thesecond actuator 306. The position or location of the additional actuator307 can enable a similar actuation as that described above when thefirst operator control interface 300 is in a configuration upside downto that shown in FIG. 1, which can occur during rotation or flipping ofthe patient on certain surgical (e.g., spine) tables.

As with all components described herein, the first operator controlinterface 300 is not limited to the exact size, configuration and/orpositioning shown in the figures attached hereto. Although the body 302is shown as being generally cylindrical and having a longitudinal axisthat extends generally in the plane defined by the link arms 218 a, 218b, the presently disclosed technology is not so limited. For example, inan alternative embodiment, the longitudinal axis of the body 302 canextend generally perpendicular to the plane defined by the link arms 218a, 218 b, and can only include the first actuator 304 at one end or sidethereof.

The body 312 of the first operator control interface 300 can bespaced-apart from the ball joint 410 and an attachment mechanism 310 ofthe first operator control interface 300. In particular, the body 312can be attached to an upper or output side of the ball joint 410 by ashaft 312. Thus, the attachment mechanism 310 can be spaced-apart fromthe body 302 and be permanently and/or fixedly attached thereto by ashaft 312. Such a configuration allows a user (e.g., surgeon) to move ordrive all axes of the system when the brake(s) 270 and the motor 420 arein the released state.

The attachment mechanism 310 can include one or more features thatpermit permanent or removable attachment to the ball joint mechanism400, one or more head supports, a second operator control interface 332,and/or a third operator control interface 240 (described in detailbelow). For example, a rotatable knob 314 or tightening clamp (see FIG.2) can be configured to move (e.g., open and/or close) vice-like jaws321 a, 321 b that can be configured to grasp a portion of a head supporttherebetween. In one embodiment, the grasped portion of the head supportcan snap into place by depression of an interior button 322. If the jaws321 a, 321 b are not sufficiently tightened by the knob 314 to properlyclamp a head support, the interior button 322 can function as a safetycatch so the head support will not inadvertently separate from theattachment mechanism 310. A release button 316 (see FIG. 1) can allowthe head support to be removed or separated from the attachmentmechanism 310. Thus, a second action (e.g., depressing the releasebutton 316) can be necessary to remove the head support from theattachment mechanism 310.

The attachment mechanism 310 can further include a first receptacle 318and a second receptacle 320. A longitudinal axis of the first receptacle318 can extend perpendicularly to a longitudinal axis of the secondreceptacle 320. The first receptacle 318 can be sized, shaped and/orconfigured to receive at least a portion one or more of the headsupports (as described in detail below), and the second receptacle 320can be sized, shaped and/or configured to receive at least a portion ofthe third operator control interface 240 (as described in detail below).Each of the receptacles 318, 320 can include one or more exposedelectrical contacts (e.g., pogo pins). It is understood by those skilledin the art that the receptacles 318, 320 are not limited to be locatedon or in the attachment mechanism 310. For example, either or both ofthe receptacles 318, 320 can be formed on or in the ball joint mechanism400, the body 302 of the first operator control interface 300, thedistal end 204 of the arm assembly 200 or the first link arm 218 a.

As shown in FIGS. 1, 2 and 16-18, the position of the first operatorcontrol interface 300 relative to other components of the system can beadvantageous. Particularly during initial set-up of the system 100and/or prior to surgery, it can be beneficial for the first operatorcontrol interface 300 to be located proximate to the upper end of theball joint mechanism 400 and/or the distal end 204 of the arm assembly200. Such proximity allows the surgeon or other healthcare professionalto have his/her hand near the free end of the arm assembly 200 and makeminute or finite changes in the position of the free end of the armassembly 200, thereby facilitating attachment to a variety ofattachments, such as a head support (embodiments described in detailbelow).

Referring to FIGS. 7-10 and 16-18, one or more head supports can beremovably attachable or fixable to one or more portions of the supportor apparatus, generally designed 100, of the presently disclosedtechnology. The system or apparatus 100 can include or be attached to avariety of different types of head supports depending upon the medicalprocedure and/or the patient's condition. One embodiment of a headsupport is a head clamp 330 shown in FIGS. 7, 17 and 18. The head clamp330 can be beneficial for long, more intrusive procedures that requiremore precise head control. Generally, head clamps are known in the art.However, one unique feature of the head clamp 330 of the presentlydisclosed technology is the manner in which it is removably attachableto a remainder of the system or apparatus.

In one embodiment, as shown in FIG. 8, an adapter, generally designated500, can permit the head clamp 330 to be removably attachable to theattachment mechanism 310 of the first operator control interface 300.The adapter 500 can also be used to secure or fix the head clamp to thearm assembly 200 or the remainder of the system 100, such that theoperator is able to selectively position and/or orient the patient'shead about any axis. A first or distal end 504 of the adapter 500 can besized, shaped and/or configured to be inserted into at least a portionof the head clamp 330. An opposing second or proximal end 502 (e.g., asecond mount) of the adapter 500 can be sized, shaped and/or configuredto be inserted into at least a portion of the second receptacle 320 ofthe attachment mechanism 310. More particularly, in one embodiment, atleast a portion of the second end 502 can be inserted into the secondreceptacle 320 of the attachment mechanism 310. In operation of oneembodiment of the presently disclosed technology, the first end 504 canbe installed on the head clamp 330 before the head clamp 330 is attachedto the patient. Once the head clamp 330 is installed on the patient, thepatient can be moved or rolled into position, and then the second end ofthe adapter 500 can be inserted into the attachment mechanism 310 orotherwise attached to the arm assembly 200.

The adapter 500 can include a wheel 512 that can rotate with respect toa remainder and/or a body 508 of the adapter 500. The wheel 512 can befixedly attached to the first end 504, which can include one or morethreads on an exterior surface thereof. The wheel 512 can be configuredto be grasped or touched by the surgeon or other healthcare provider,such that rotation of the second portion 512 can rotate the first end504, thereby moving the first end 504 into or out of engagement with amating female thread of the head clamp 330. Thus, the wheel 512 can berotated to tighten the adapter 500 to the head clamp 330. As a result,the second end 502 of the adapter 500 can serve as a quick connectioninto the attachment mechanism 310 (e.g., the second end 502 can latchinto position (via the interior button 322), and then the second end 502can be clamped tightly into the attachment mechanism 310). This quickconnection can be beneficial as it can limit the time the surgeon orother healthcare professional needs to steady the patient's head whileengaging the head clamp 330 to the first operator control interface 300.

A plate 510 or a portion of the body 508 can include a series ofspaced-apart ridges or teeth 514 that can be sized, shaped and/orconfigured to complementarily engage spaced-apart grooves or teeth ofthe head clamp 330. The combination of complementary teeth can lock orfix the head clamp 330 to the adapter 500, which in turn can be lockedto the attachment mechanism 310. In one embodiment, the plate 510 can beremovably attachable to the body 508. In one embodiment, the system 100can include two or more plates 510, each of which can have a uniqueteeth pattern or size. The plates 510 can be selectively attached to orremoved from the body 510 to accommodate different brands or styles, forexample of head clamps 330.

Another embodiment of a head support is a head support plate 332 shownin FIGS. 9, 10 and 16. A conventional support mask, helmet, pillow orother device can be mounted onto the head support plate 332. The headsupport plate 332 can be beneficial for shorter, less intrusive orinvasive procedures that require less head control, or for lumbar orthoracic spine procedures where the cervical spine is not compromised.The head support plate 332 can include an upper plate 340 spaced-apartfrom a lower plate 342. The upper plate 340 can include an opening 341therein, and the lower plate 342 can include a mirrored surface orportion. At least a portion of the patient's face can be placed in oraligned with the opening 341. The lower plate 342 can move or pivot withrespect to the upper plate 340. This configuration allows a healthcareprofessional, such as an anesthesiologist, to easily and quickly see thepatient's face during the medical procedure. A projection 344 (e.g., athird mount) with one or more exposed electrical contacts can extendoutwardly from the head support plate 332. At least a portion of theprojection 344 can be sized, shaped, and/or configured to matinglyengage one or both the first and second receptacles 318, 320 of theattachment mechanism 310 of the first operator control interface 300,such that the electrical contact(s) of the projection 344 can engage theelectrical contact(s) of the first receptacle 318 or the secondreceptacle 320.

The head support plate 332 can include or be in the form of the secondoperator control interface. More particularly, the head support plate332 can include a first or left handle 334 spaced-apart from a second orright handle 336. In one embodiment, each of the first and secondhandles 336 can be positioned on a bottom side of the upper plate 340,and can be engaged when moved or pressed upwardly toward a top surfaceof the upper plate 340. Each of the first and second handles 334, 336 ofthe head support plate 332 can be operatively and/or electricallyconnected to the motor 420 of the ball joint mechanism 400 and/orbrake(s) 270 of one or more of the joints 220 a, 220 b, 220 c. In oneembodiment, each handle 334, 336 can include an actuator or releasetrigger 334 a, 336 a on an inside surface thereof. Such a design canrequire the user to wrap his or her fingers completely around eachhandle 334, 336 before the actuator 334 a, 336 a can be exercised,engaged or depressed. In this embodiment, each of the first and secondhandles 334, 336 and the actuators 334 a, 336 a of the head plate 332can be operatively and/or electrically connected to the motor 420 of theball joint mechanism 400 and/or brake(s) 270 of one or more of thejoints 220 a, 220 b, 220 c. One goal of such an embodiment can be torequire the user to exert control over the system 100 and/or headsupport plate 332 before the brake(s) 270 and ball joint 410 can bereleased. In one embodiment, it can be required that both the left andright triggers 334 a, 336 a be actuated before the brake(s) 270 is/arereleased, thus ensuring the safety of the system 100 and the headsupport plate 332. In on embodiment, the head plate 332 can include arotatable knob similar in structure and functionality to that describedbelow for the third operator control interface.

Thus, with the patient's head supported on or by the head support plate332, the surgeon or other healthcare professional can selectively movethe head support plate 332 and/or the patient's head by engagement ofone or both of the first and second handles 334, 336 and/or theactuators 334 a, 336 a. The positioning of the first and second handles334, 336 and/or the actuators 334 a, 336 a can be advantageous, as thesurgeon or other healthcare professional can have his/her hands veryclose to the patient's head during movement of the head support plate332. This gives the surgeon or other healthcare professional increasedcontrol of the movement of the patient. In addition, the surgeon orother healthcare professional would not be required to go behind orbeneath the surgical drape to move or reposition the patient.

FIG. 11 shows a perspective view of a third operator control interface240. The third operator control interface 240 can include one or morespaced-apart handles 242 a, 242 b, which can be coupled to extensions or“horns” 244 that are attached to a housing 246 (e.g., fourth mount). Thehousing 246 can include one or more exposed electrical contacts. Atleast a portion of the housing 246 can be sized, shaped and/orconfigured to engage or be received in one or both of the first andsecond receptacles 318, 320 of the attachment mechanism 310 of the firstoperator control interface 300, such that the electrical contact(s) ofthe housing 246 can engage the electrical contact(s) of the firstreceptacle 318 or the second receptacle 320. A rotatable knob 248 can befixed to a shaft 250 that is insertable into and extendable through atleast a passageway in the housing 246. The knob 248 can allow thesurgeon or other healthcare professional to tighten, lock or moresecurely attach the third operator control interface 240 to the firstoperator control interface 300, and/or loosen or prepare to release thethird operator control interface 240 from the first operator controlinterface 300.

Each handle 242 a, 242 b can include one or more an actuators 244 a, 246a, 244 b, 246 b. Two or more of the actuators 246 a, 246 b can be in theform of a spring-actuated trigger or tab, which can be depressed and/orengaged by a user's palm when the user grasps the handle 242 a, 242 b,respectively. Two or more of the actuators 244 a, 244 b can be in theform a spring-actuated push button, which can be depressed and/orengaged by a user's finger. In operation, when the user grasps thehandle 242 a, 242 b, it can be most comfortable for the user to depressthe actuators 244 a, 244 b with his or her thumb. Each of the actuators244 a, 246 a, 244 b, 246 b of the third operator control interface 240can be operatively and/or electrically connected to the motor 420 of theball joint mechanism 400 and/or brake(s) 270 of one or more of thejoints 220 a, 220 b, 220 c. It is understood that the actuators 244 a,244 b, 246 a, 246 b can be coupled to the joints 220 a, 220 b, 220 cand/or the ball joint mechanism 400 in any appropriate manner. As aresult of the coupling or connection, the surgeon or other healthcareprofessional can move or reposition the patient through engagement ofone or both of the actuators 244 a, 246 a, 244 b, 246 b.

In operation of one embodiment, the handles 242 a, 242 b allow accuratepositioning of the patient's head, through movement of the head clamp230, for example, when the joints 220 a, 220 b, 220 c and/or the balljoint mechanism 400 are in an unlocked state. This can be accomplishedby the surgeon, or other personnel, grasping one or both of the handles242 a, 242 b and actuating the actuators 244 a, 244 b after actuatingthe actuators 246 a, 246 b, to place the joints 220 a, 220 b, 220 cand/or the ball joint mechanism 400 in an unlocked state and moving thehandles 242 a, 242 b to desired positions. Releasing the actuators 244a, 244 b, 246 a, 246 b can place the joints 220 a, 220 b, 220 c and/orthe ball joint mechanism 400 in a locked state to retain the desiredposition. This configuration does not permit inadvertent movement of thepatient's head or when the surgeon does not have a balanced, two-handed,grasp of the handles 242 a, 242 b.

In one embodiment, the surgeon can be required to engage (e.g., firmlygrip) both handles 242 a, 242 b before he/she is able to release thebrake(s) 270 and/or the joint(s) 220. In this embodiment, an algorithmof the system 100 can require that both enable buttons 246 a, 246 b beengaged, depressed or fully depressed before any motion of the system100 is permitted or possible. Then, with a firm grip established, thesurgeon can easily and ergonomically release one or both trigger buttons244 a, 244 b. This will provide a high level of safety by assuring thephysician is ready and capable to support the weight of the patient'shead.

Furthermore, the algorithm can allow for three modes of release. Forexample, in one embodiment, if only one trigger button 244 a, 244 b isactuated or depressed, the ball joint 410 can unlock allowing coronalplane and roll motion. If the other trigger button 244 a, 244 b isactuated or depressed, one or more of the brakes(s) 270 can be released,thereby allowing sagittal plane adjustment. If both trigger buttons 244a, 244 b are released or engaged together or simultaneously, then alljoints (e.g., each brake 270 and the ball joint 410) can be released. Assoon as any enable or trigger button 244 a, 244 b is released, all axescan immediately lock-up.

Referring to FIGS. 12-18, the system or apparatus can include a base toremovably attach the arm assembly 200 to the support apparatus 150. Itcan be beneficial if the arm assembly 200 is able to move with respectto the support apparatus 150 to provide the surgeon or other healthcareprofessional with additional options for moving or repositioning thepatient. Thus, it can be beneficial that the base of the presentlydisclosed technology can move in two degrees (e.g., in an X directionand in a Y direction) with respect to the support apparatus 150.

As shown in FIGS. 12, 13 and 16, one embodiment of the base, generallydesignated 600, can include a first body 602 and a second body 604. Thefirst body 602 can be configured to contact or attach directly to aportion of the support apparatus 150. The second body 604 can include areceptacle 606 that can be sized, shaped and/or configured to receive atleast a portion of the body 260 of the first mount 230. A rotatable knob608 can be fixed to a shaft that is insertable into and extendablethrough at least a passageway in the second body 604. The knob 608 canallow the surgeon or other healthcare professional to tighten or moresecurely attach the arm assembly 200 to the base 600, and/or loosen orprepare to release the arm assembly 200 from the base 600.

The second body 604 can be configured to move with respect to the firstbody 602. More particularly, a portion of the second body 604 caninclude one or more ball or roller bearings that can engage and/or rideon a rail 610 of the first body 602. Thus, the second body 604 can movegenerally perpendicularly to a longitudinal axis of the patient and/or aplane in which the arm assembly 200 extends. A locking tab or handle 612can be attached to the second body 604, and can be movable between afirst or locked position and a second or unlocked position. In thelocked position, the locking tab 612 can engage a brake mechanism thatgrasps at least a portion of the first body 602 (e.g., the rail 610) orotherwise prevents the second body 604 from moving with respect to thefirst body 602. In the unlocked position, the brake mechanism isreleased and/or the locking tab 612 does not interfere with or canpermit the second body 604 to be moved with respect to the first body602. In one embodiment, to move the second body 604 with respect to thefirst body 602, the locking tab 612 can be rotated from the lockedposition to the unlocked position. The surgeon or other healthcareprofessional can grasp or otherwise touch a portion of the system 100,such as the arm assembly 200, the skull clamp 330, the steer horns 240or the prone platform 332 and easily move or adjust the second body 604laterally. This allows the surgeon place the patient's head exactlywhere he/she needs it. The rail 610 and bearing(s) provide the lowfriction and rigidity to make this nearly effortless.

The first body 602 can be configured to lock onto and/or move or slidewith respect to the support apparatus 150. In particular, in oneembodiment, opposing lateral sides of the first body 602 can eachinclude a two-part or two-stage clasp mechanism. For the sake of brevityand convenience only, portions of the below description may focus on theclasp mechanism on only one of the lateral sides of the first body 602,though it is understood that the opposing lateral side can include themirror structure and functionality. More particularly, one or eachopposing side of the first body 602 can include a first clasp 614 a, 614b that can include and be fixed to a pin 616 that extends along a Y axis(e.g., parallel to the direction in which the patient extends). As shownin FIGS. 13B-F, the pin 616 can engage and/or extend through a slot in ahousing 628 of the first body 602, which can enable the pin 616 (andthus the first clasp 614) to pivot (e.g., rotate) and/or translate(e.g., move linearly) vertically.

Each first clasp 614 a, 614 b can include a portion that extendsvertically downwardly from the pin 616 a, 616 b and another portion thatextends generally perpendicularly thereto to extend beneath at least aportion of the support apparatus 150. The segment of the first clasp 614that can be positionable below the support apparatus 150 (e.g., the“horizontal” segment of the first clasp 614) can include one or morespaced-apart compressible friction members 630. In one embodiment, eachcompressible friction member 630 can be a rubber grommet. Each firstclasp 614 a, 614 b can move between a first, non-engaged position and asecond, engaged position (see FIGS. 12 and 13A-F). One or each opposingside of the first body 602 can also include second clasps 618 a, 618 bthat can pivot about the pin 616 and can be positioned in a longitudinalmidsection of the first clasp 614 a, 614 b. Each second clasp 618 a, 618b can move, rotate and/or pivot with respect to the respective firstclasp 614 a, 614 b. Similar to the first clasps 614 a, 614 b, eachsecond clasp 618 a, 618 b can move between a first, non-engaged position(see, e.g., FIGS. 13B-13D) and a second, engaged position (see FIGS. 12,13A, 13E and 13F). As shown in FIGS. 13D and 13F, each second clasp 618can include a cam or cam surface 632, which can selectively engage asecond pin 634 fixed in the housing 620 and/or a roller 636 that cansurround the second pin 634.

In one embodiment, when the second clasp 618 is in the second, engagedposition, the cam surface 632 of the second clasp 618 can act againstthe second or fixed pin 634 and roller 636 (see FIG. 13F), therebycausing the first clasp 614 to move upwards, forcing the compressiblefriction member(s) 630 into engagement with at least a portion of thesupport apparatus 150, such that the base 600 cannot move with respectto the support apparatus 150 along the Y or longitudinal axis. Inoperation, the compressible friction member(s) 630 can be at leastslightly compressed under the force of engagement with the first clasp614 and the support apparatus 150, thereby creating a high frictionsurface. When the second clasps 618 a, 618 b are in the first,non-engaged position (see FIGS. 13B-13D), the first clasps 614 a, 614 bcan either be (i) in the first, non-engaged position such that the base600 can be separated from the support apparatus 150 (see FIG. 13B) or(ii) in the second, engaged position such that the base 600 can contactand/or move with respect to the support apparatus 150 along the Y orlongitudinal axis (see FIGS. 13C and 13D). At least a slight clearancegap G (see FIG. 13C) between the housing 628 or another portion of thefirst body 602 and the grommet(s) 630, when the first clasp 614 is inthe downward position but the second clasp 618 is in the upwardposition, can enable or allow for the movement of the base 600 withrespect to the support apparatus 150. Thus, the first clasps 614 a, 614b can function to (i) generally hold the base 600 in place on thesupport apparatus 150, (ii) generally prevent inadvertent movementthereof, and/or (iii) allow the base 600 to slide or otherwise move withrespect to the support apparatus 150 without being separated from thesupport apparatus. The second clasps 618 a, 618 b can function togenerally lock the base 600 in place on the support apparatus 150.

In one embodiment, the first clasps 614 a, 614 b are configured torotate into position under the table support spars and latch intoposition. A spring-actuated finger latch 638 can be positioned in alongitudinal midsection of each first clasp 614. The latch 638 can becovered or otherwise at least partially concealed by the second clasp618 when the second clasp 618 is closed or rotated downwardly (see FIGS.13C-13F), but at least partially exposed or visible to the user whensecond latch 618 is open or rotated upwardly (see FIGS. 13A and 13D).The latch 638 can be configured to hold the first clasp 614 in thelatched, locked or downward orientation by engaging a portion of thehousing 628 or other portion of the first body 602. In one embodiment,as shown in FIG. 13D, the user or surgeon can be required to engageand/or rotate the latch 638 (e.g., clockwise in FIG. 13D) to allow thefirst clasp 614 to reopen. The cam or cam surface 632 of the secondclasp 618 can drive the first clasp 614 upwardly and thereby enable itto grip at least a portion of one of the spars of the support apparatus150. As shown in FIGS. 13C and 13E, passive or complementary lockingtabs 640, 642 on the first clasp 614 and the housing 628, respectively,can engage in this position, assuring the that first clasp 614 cannot beopened by any jarring impact. This combination allows for threeindependent or separate states of the clasp mechanism: (i) both fullyopen and unlocked so that the base 600 can be placed on the table 150,(ii) first clasps 614 a, 614 b latched so the base 600 cannot be liftedoff the table 150, yet it is free to translate along the table 150,(iii) the second clasps 618 a, 618 b latched, which drives the firstclasps 614 a, 614 b upwardly to grip the table 150 tightly so the base600 is fully constrained.

As shown in FIGS. 14, 15, 17 and 18, a second embodiment of the base,generally designated 600′, can include many or all of the features ofthe base 600 of the first embodiment. The same or similar features ofthe base 600′ of the second embodiment are shown with the same referencenumber as in the first embodiment, but with the addition of a prime (′)symbol. A description of the same or similar features is omitted hereinfor the sake of clarity and brevity only. One distinguishing feature ofthe base 600′ of the second embodiment is that the first body 602′ caninclude three or more components that are configured to move relative toone another, thereby adding an additional degree of control or movementto the system.

In particular, the first body 602′ can include a first end 620 a′, asecond end 620 b′, and a mount 624′ therebetween. The mount 624′ canmove (e.g., slide) with respect to the first and second ends 620 a′, 620b′. More particularly, opposing ends of the mount 624′, which contact orengage the first and second ends 620 a, 620 b′, respectively, caninclude one or more ball or roller bearings that can engage and/or rideon at least a portion of the first and second ends 620 a′, 620 b′. Thus,in addition to the horizontal or lateral movement that the second body604′ can provide, the first body 602′ of the second embodiment of thebase 600′ can provide longitudinal movement. As shown in FIG. 14, a topsurface of each of the first and second ends 620 a′, 620 b′ can includedistance markings or a ruler, which can be used to track the relativemovement of the mount 624′ to the first and second ends 620 a′, 620 b′to help the surgeon or other healthcare professional position orreposition the patient.

At least one or two or more locking levers or handles 626 a′, 626 b′ canbe attached to the mount 624′, and can be movable (e.g., rotatable)between a first or locked position and a second or unlocked position. Inthe locked position, each locking lever 626 a′, 626 b′ can grasp atleast a portion of the first and second ends 620 a′, 620 b′,respectively, or otherwise prevent the mount 624′ from moving withrespect to the first and second ends 620 a′, 620 b′. In the unlockedposition, each locking lever 626 a′, 626 b′ does not interfere with orcan permit the mount 624 each locking lever 626 a′, 626 b′ to be movedwith respect to the first and second ends 620 a′, 620 b′. Theabove-described longitudinal adjustment provided by the base 600′ hasmany benefits. For example, this design can provide easy adjustmentsduring patient set-up to connect the arm assembly 200 to the skull clamp330 rather than releasing the second clasps 618 a′, 618 b′ and slidingthe entire unit. This design can provide increased range of motionduring intraoperative adjustments; the low friction allows user to guidethe patients head rather than having to push or move the base 600′and/or the first body 602′. This design can provide static traction; thesurgeon can release the levers 626 a′, 626 b′, pull the unit and/or thesecond body 604′ longitudinally and apply a certain amount of tractionto distend the neck of the patient. This design can provide activetraction; the surgeon can release levers 626 a′, 626 b′ and apply aweight bag via pulleys (for example) to the base 600′ and/or the secondbody 604′ and apply a constant force traction.

Referring to FIGS. 17 and 18, in one embodiment, instead of the armassembly 200 being directly attached to the base 600, 600′, a tower 700can be positioned between the arm assembly 200 and the base 600, 600′.More particularly, the first mount 230 of the arm assembly 200 can beinserted into a receptacle of the tower 700, and a projection (e.g.,fifth mount) of the tower 700 can be inserted at least partially orcompletely into the receptacle 606, 606′ of the base 600, 600′. Thetower 700 can permit the proximal end 202 of the arm assembly 200 to bevertically raised or lowered (e.g., along the Z axis) with respect tothe base 600, 600′. A rotatable crank 702 can be located at a top orbottom of the tower 700, which can allow the surgeon or other healthcareprofessional to selectively raise or lower the proximal end 202 of thearm assembly through any of a variety of different mechanisms (e.g.,lead screw or rack and pinion system). The tower 700 can provide movevertical movement or range to the system 100. For example, the tower 700can provide a “stroke” of six to seven inches.

The term “surgical table” is broadly defined herein to include anystructure to which the system 100 can be attached to and supported byduring a medical procedure. Any type, style, size and/or configurationof surgical table can be used as part of or attached to the system 100of the presently disclosed technology. For example, surgical tablesdisclosed in U.S. Published Application No. 2016/0228315 can be used incombination with the presently disclosed technology. The system 100 isnot limited to be used with a surgical table in the form of an H-framewith rectangular supports. Further, various patient support attachmentsand other devices can be used in combination with the invention.

In operation, at least a portion of one, two or each of the firstoperator control interface 300, the second operator control interface332, and the third operator control interface 240 can be engaged ormanipulated by the surgeon or other healthcare professional to provideor create the desired inter-operative movement of the patient. In oneembodiment, one or more of the actuators or buttons of one or more ofthe first operator control interface 300, the second operator controlinterface 332, and the third operator control interface 240 can beengaged to progressively or sequentially release, unlock or lock theball joint 410 and/or the joints 220 a, 220 b, 220 c. In such anembodiment, one goal can be to sequentially release the brake(s) 270,thereby providing (i) additional movement of the system 100 upon releaseof each brake 270 and giving the surgeon more control, and/or (ii) slowor predictable transfer of weight from the system 100 to the surgeonand/or other healthcare professional. To perform a different operationin the same embodiment, or in a different embodiment, one or more of theactuators or buttons of one or more of the first operator controlinterface 300, the second operator control interface 332, and the thirdoperator control interface 240 can be engaged to release, unlock or lockin parallel or simultaneously. Of course, the actuators or buttons couldbe engaged in any combination of in parallel or in series. For example,in one embodiment, movement (of at least one of the ball joint 410and/or the joints 220 a, 220 c, 220 c) may not begin until two actuators(e.g., the first actuator 304 and the second actuator 306 of the firstoperator control interface 300) are depressed or engaged (e.g., eitherin series or in parallel). In another embodiment, engagement of one ofthe actuators can allow the system 100 to move in one plane (e.g., thesagittal plane); engagement of a second one of the actuators can releasethe ball joint 410, thereby allowing for both roll and yawl movement;engagement of both actuators can permit all degrees of motion ormovement. In one embodiment, upon engagement of one or each of theactuators or buttons, the system 100 can configured to perform (e.g.,begin) the desired movement or motion within approximately 300milliseconds, which is a typical human reaction time. This is asignificant improvement over the prior art, and ensures that patientpositioning and repositioning can be done quickly and with relative eachby the medical staff.

As shown in FIGS. 16-18, the location and/or position of each of thefirst operator control interface 300, the second operator controlinterface 332, and the third operator control interface 240 can bebeneficial. In one embodiment, the position of each of the operatorcontrol interfaces 300, 332, 240 can allow the surgeon or otherhealthcare professional (i) to move and/or control the patient's headthrough the drapes (ii) while scrubbed in, and (iii) while maintainingsight of the surgical site and without relying on assistance from anyother person. Each of the operator control interfaces 300, 332, 240 canbe accessible from above the patient and/or are exposed above thepatient.

In one embodiment, as shown in FIGS. 19 and 20, the system 100 isconfigured to complement and/or can include a surgical drape 900. Thedrape 900 can be designed to cover at least a portion of, the entiretyof, and/or interface with not only to the patient, but also to at leastsome or all of the operator control interfaces 300, 332, 240 of thesystem 100. In one embodiment, the drape 900 can allow a sterile surgeonor other healthcare professional (i) to directly move, adjust and/orcontrol the position of the third operator control interface 240 andthus adjust the position and orientation of the patient's head throughthe drapes (ii) while scrubbed in (i.e., while remaining completelysterile), and/or (iii) while maintaining sight of the surgical site,without disturbing the drape/patient interface at the surgical site, andwithout relying on assistance from any other person.

Such inter-operative adjustment cannot be done with any prior artsystem. In contrast, when attempting to move a patient's head in asterile manner during surgery in prior art systems, one member of themedical team is required to go beneath the surgical table and/or thepatient's head, and then rescrub after the adjustment is made. Thesurgical site remains sterile during this adjustment in prior artsystems, but the procedure is can be clumsy, challenging, andtime-consuming.

In one embodiment, during a medical procedure, the third operatorcontrol interface 240 including the actuators 244 a, 244, 246 a, 246 bcan be accessible from above the patient and/or are exposed above thepatient and accessible through the drape 900. The drape 900 can beentirely transparent. Alternatively, the surgical drape can be primarilyopaque and include one or more spaced-apart transparent windows orpockets 902 to allow the third operator control interface 240 to beidentified, grasped and/or engaged through the draft 900 by the user orsurgeon. Thus, the drape 900 can be contoured to allow the thirdoperator control interface 240 to be identified and easily grippedthrough the drape 900 by the user, without disturbing the drape 900 atthe location of the surgical site. A transparent sock can be applied toat least a portion of the third operator control interface 240 prior tothe application of the drape 900 to provide a second transparentprotective barrier. Other embodiments of the drape 900 can provideinterfaces or pockets to the first and second operator controlinterfaces 300, 322 and/or other actuators or controls 612, 626 a′, 626b′ of the system 100 in similar manners.

The electrical nature of the system 100 can also provide feedback whenmovement of any portion of the system 100 occurs. For example, uponengagement of one of the actuators and movement of at least one of thejoints 220, 220 b, 220 c, the system 100 can emit a tone, display animage or word on a monitor, illuminate a light or series of lights, orthe like. The feedback can also be in the form of data, such as thespeed, angle, range, displacement, etc. of the movement. Such feedbackcan be helpful to a surgeon or other healthcare professional in any of avariety of ways, such as for teaching others how to perform surgery, forrepeating successful surgeries, and/or for legal matters, such asmalpractice claims.

It will be appreciated by those skilled in the art that changes could bemade to the embodiments described above without departing from the broadinventive concept thereof. For example, various mechanical andelectrical connection elements and actuators can be used to achieve thedisclosed function. It is understood, therefore, that this invention isnot limited to the particular embodiments disclosed, but it is intendedto cover modifications within the spirit and scope of the presentinvention as defined by the appended claims.

We claim:
 1. A system for positioning a patient before, during or aftera medical procedure, the system comprising: an arm assembly having aproximal end, an opposing distal end, and at least one joint therebetween, the at least one joint comprises an electromagnetic brake and agear drive, the at least one joint being configured to permit the distalend of the arm assembly to move with respect to the proximal end of thearm assembly, the proximal end of the arm assembly being configured tobe fixed with respect to a surgical table; and a ball joint mechanismattached to (i) the distal end of the arm assembly and (ii) a headsupport configured to support a patient's head, the ball joint mechanismincluding a ball joint and a motor, wherein activation of the motorpermits or prevents rotation of the ball joint.
 2. The system of claim1, wherein the ball joint mechanism further includes a clutch and two ormore gears.
 3. The system of claim 2, further comprising: a firstoperator control interface located proximate to the ball jointmechanism, the first operator control interface including at least oneactuator, wherein, upon activation by a user, the actuator of the firstoperator control interface is configured to activate the motor therebyenabling movement of the arm assembly and the patient's head.
 4. Thesystem of claim 3, further comprising: the head support including anupper plate spaced-apart from a lower plate, the lower plate beingpivotable with respect to the upper plate, the upper plate including anopening therein, the opening separating a first actuator from a secondactuator, the lower plate including a mirrored surface, wherein, uponactivation by a user, at least one of the first and second actuators ofthe upper plate is configured to activate the motor thereby enablingmovement of the patient's head in a sterile manner by a sterileoperator.
 5. The system of claim 3, further comprising: the head supportincluding at least one exposed electrical contact, wherein the firstoperator control interface includes at least one receptacle having atleast one exposed electrical contact, and wherein the electrical contactof the first operator control interface is configured to engage theelectrical contact of the head support.
 6. The system of claim 5,further comprising: the head support including two spaced-apart handles,each handle being accessible through a drape covering at least a portionof the patient, each handle being coupled to an extension attached to ahousing, the housing having one or more exposed electrical contactsconfigured to engage the at least one exposed electrical contact of thefirst operator control interface, each handle having an actuator,wherein, upon activation by a user, at least one of the actuators of thehandles is configured to activate the motor thereby enabling movement ofthe patient's head in a sterile manner by a sterile operator.
 7. Thesystem of claim 1, wherein the gear drive providing inertial dampeningto the at least one joint, wherein the ball joint is released before orafter the brake.
 8. The system of claim 7, wherein the arm assemblyincludes at least two arm links attached by the at least one joint, atleast one of the two arm links includes or is coupled to at least onepower source operatively connected to at least one of theelectromechanical brake and the motor of the ball joint mechanism. 9.The system of claim 1, wherein the at least one joint includes threespaced-apart joints connected by two arm links.
 10. The system of claim1, further comprising: a base configured to be attached to a surgicaltable and a proximal end of the arm assembly, the base including a firstbody and a second body, the first body being attachable to the surgicaltable and movable with respect to the surgical table along a first axis,the second body being movable with respect to the first body in adirection perpendicular to the first axis.
 11. The system of claim 10,wherein the first body includes a first end, an opposing second end, anda mount there between, the mount being movable with respect to the firstand second ends along the first axis.
 12. The system of claim 10,wherein the first body comprises at least one first clasp and at leastone second clasp, each of the first and second clasps pivoted between alocked position and an unlocked position.
 13. The system of claim 10,wherein the second clasp is positioned within the first clasp, andwherein the first body can move along the first axis with respect to thelongitudinal axis when (i) the first clasp is in the locked position and(ii) the second clasp is in the unlocked position.
 14. A system forpositioning a patient before, during or after a medical procedurewithout compromising sterility of a medical site, the system comprising:a surgical table; a base removably attachable to the surgical table; ahead support configured to contact the patient's head, at least aportion of the head support including at least one exposed electricalcontact; an arm assembly having a proximal end, an opposing distal end,at least three spaced-apart joints there between, and at least two armlinks that attach the joints, each joint being configured to permit thedistal end of the arm assembly to move with respect to the proximal endof the arm assembly, the proximal end of the arm assembly beingconfigured to be fixed with respect to the base attached to the surgicaltable, at least one of the joints including at least oneelectromechanical brake and a gear drive; and a ball joint mechanismattached to (i) the distal end of the arm assembly and (ii) the headsupport, the ball joint mechanism including a ball joint and a motor,wherein activation of the motor permits or prevents movement of the balljoint.
 15. The system of claim 14, further comprising: a first operatorcontrol interface including at least one actuator, wherein the balljoint mechanism includes a clutch, and wherein, upon activation by auser, the actuator is configured to activate the motor.
 16. The systemof claim 14, wherein the head support includes an upper platespaced-apart from a lower plate, the lower plate being pivotable withrespect to the upper plate, the upper plate including an openingtherein, the opening separating a first actuator from a second actuator,the lower plate including a mirrored surface, wherein, upon activationby a user, at least one of the first and second actuators of the upperplate is configured to activate the motor.
 17. A system for positioninga patient before, during or after a medical procedure, the systemcomprising: a base including a first body and a second body, the firstbody being attachable to a surgical table and movable with respect tothe surgical table along a first axis, the second body being movablewith respect to the first body in a direction perpendicular to the firstaxis; and an arm assembly having a proximal end, an opposing distal end,and at least one joint there between, the joint being configured topermit the distal end of the arm assembly to move with respect to theproximal end of the arm assembly, at least a portion of the proximal endof the arm assembly being to be inserted into the first body of the baseand fixed thereto, the at least one joint including an electromechanicalbrake and a gear drive.
 18. The system of claim 17, further comprising:a ball joint mechanism attached to (i) the distal end of the armassembly and (ii) a head support configured to support a patient's head,the ball joint mechanism including a ball joint, a motor and a clutch,wherein activation of the motor permits or prevents movement of the balljoint.
 19. The system of claim 18, further comprising: an operatorcontrol interface including two spaced-apart handles each coupled tohorns, the horns being attached to the ball joint mechanism; and asurgical drape configured to cover the operator control interface and atleast a portion of the patient, the surgical drape allowing a surgeon toaccess the handles of the operator control interface to adjust thepatient while scrubbed in and while maintaining sight of a medical site.20. The system of claim 17, wherein the first body includes a first end,an opposing second end, and a mount there between, the mount beingmovable with respect to the first and second ends along the first axis.21. The system of claim 20, wherein the first body includes at least onefirst clasp and at least one second clasp, each of the first and secondclasps pivotable between a locked position and an unlocked position.